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�ACKWATER PREVENTlC1N DEVIGE PRUGRAM <br />C�ur recards indicate that a backwater preuention device must be �nstalled €�n your <br />sewer connection to cor�-sply with the new ordinance. Please help us verify fhat our <br />information is correct by answering the following questions abaut your property: <br />Da you have a basement? Yes No ❑ <br />If yes, does it have plumbing fixtures (sink, toil�t, floor drain, etc.)? Yes No ❑ <br />Da yau have a backwater valve an your sewer line? Yes ❑ No ❑ Don't Know <br />Do you have a�rinder pump in your basement? Yes ❑ No ❑ Qan't Know <br />� �� � <br />iJarne: � �'� ��- � <br />Praperty address: �� � �� � � � <br />Phone 9 : � � � � � �� Phone 2: <br />Email: � ��'�"''�"�� � �� ��a �.�� <br />